Zbytniewski Marcin, Gryszko Grzegorz M, Cackowski Marcin M, Sienkiewicz-Ulita Anna W, Woźnica Katarzyna, Dziedzic Michał, Orłowski Tadeusz M, Dziedzic Dariusz A
Department of Thoracic Surgery, National Research Institute of Chest Diseases, Warsaw, Poland.
Faculty of Mathematics and Information Science, Warsaw University of Technology, Warsaw, Poland.
Transl Lung Cancer Res. 2023 Aug 30;12(8):1717-1727. doi: 10.21037/tlcr-22-752. Epub 2023 Aug 14.
The theoretical advantage of academic hospitals over nonacademic are: more qualified surgeons, adequate diagnostic facilities and infrastructure, including intensive care units. The aim of the study was to compare the effectiveness of surgical lung cancer treatment in academic (ACA) and nonacademic (non-ACA) centers.
This was a retrospective analysis of data from 31,777 patients surgically-treated for lung cancer during the period from 2007 to 2020 in 9 ACA and 21 non-ACA centers. The analysis considered the clinical data of patients, the effectiveness of preoperative diagnostics, the type of procedures performed, the complications, the postoperative mortality and the long-term survival.
The median number of anatomical lung resection procedures was 1,218 for ACA and 550 for non-ACA centers. In the ACA group, resection using the video-assisted thoracic surgery (VATS) technique was performed significantly more often than in the non-ACA group (23.6% 14.2%, P<0.001). The pN feature analysis showed significantly lower proportions of pNX (9.2%) in the ACA group than those in the non-ACA group (17.1%) (P<0.001). The rates of postoperative complications in the ACA and non-ACA groups were 30.7% and 33.8%, respectively (P<0.001). There were no significant differences in 5-year survival between the ACA and non-ACA groups (56% and 56%, respectively) (P=0.2).
The present study showed that ACA centers are characterized by better preoperative diagnostics, a higher percentage of VATS lobectomies, a lower percentage of postoperative complications and a shorter hospitalization period than non-ACA centers, but there was no impact on 5-year survival.
学术型医院相对于非学术型医院的理论优势在于：有更合格的外科医生、充足的诊断设施和基础设施，包括重症监护病房。本研究的目的是比较学术型（ACA）和非学术型（非ACA）中心在手术治疗肺癌方面的有效性。
这是一项对2007年至2020年期间在9个ACA中心和21个非ACA中心接受肺癌手术治疗的31777例患者的数据进行的回顾性分析。分析考虑了患者的临床数据、术前诊断的有效性、所进行的手术类型、并发症、术后死亡率和长期生存率。
ACA中心解剖性肺切除手术的中位数为1218例，非ACA中心为550例。在ACA组，使用电视辅助胸腔镜手术（VATS）技术进行切除的频率明显高于非ACA组（23.6%对14.2%，P<0.001）。pN特征分析显示，ACA组中pNX的比例（9.2%）明显低于非ACA组（17.1%）（P<0.001）。ACA组和非ACA组的术后并发症发生率分别为30.7%和33.8%（P<0.001）。ACA组和非ACA组的5年生存率无显著差异（分别为56%和56%）（P=0.2）。
本研究表明，与非ACA中心相比，ACA中心的特点是术前诊断更好、VATS肺叶切除术的比例更高、术后并发症的比例更低且住院时间更短，但对5年生存率没有影响。
